Cardiovascular is the top-performing service line for Lourdes Health System in southern New Jersey, and CEO Alexander Hatala intends to keep it that way, even as the health system overhauls its care delivery to improve value.

That's why Lourdes entered into a co-management model with its cardiologists. "Turning over the responsibility to the physicians aligns the physicians and the hospital to the same clinical and economic objections — and — incentivizes the physicians to achieve performance," Hatala says.

The agreement went into effect in 2011, shortly after Lourdes hired 48 cardiologists through the acquisition of two practice groups. Another 30 cardiologists who work at Lourdes re-main independent.

"We wanted to harness the talents and energies and entrepreneurial spirit of these cardiologists who had been owners of their own practices for years and years," says Reginald Blaber, M.D., executive director and vice president of cardiovascular services at Lourdes. "I think we have been successful as evidenced by what they've been able to accomplish in a rather short amount of time."

For example, Our Lady of Lourdes Medical Center reduced door-to-balloon time from 66 to 44 minutes in just a few months. The improvement came after cardiologists persuaded the system to spend $30,000 on software that allows EKGs taken by emergency medical technicians to be wirelessly transmitted to the emergency department so treatment can be started soon after a patient arrives.

Other improvements: Lourdes began saving nearly $800 per angioplasty after its interventional cardiologists were presented information about the unexplained clinical variation from evidenced-based guidelines. And the average length of stay for cardiovascular surgery patients dropped significantly — from 10 days to seven — after the hospital created a transitional unit staffed with highly skilled nurses that allows cardiac patients to leave the intensive care unit more quickly.

Under the co-management arrangement, cardiologists are accountable for the quality, patient satisfaction, operational efficiency, costs and overall financial success of Lourdes' cardiovascular line.

"Our responsibility is to support them with the necessary resources so that the things that they decide are important do occur," Blaber says.

The financial incentives for cardiologists did not start until this fall — more than a year after the co-management went into effect. Blaber says physicians and administrators worked on the goals, metrics and incentive structure together.

While the pay-for-performance program is essential, it is not the most important success factor, Blaber says.

"The thing that co-management requires more than anything else is a working relationship of the cardiologists with hospital administration," he says. "First of all, if there's no trust, the hospital administrators will never give the physicians the leadership. And if the physicians don't trust the motivations of the administration, they are not going to really come to the table in an earnest and sincere way."